1C), and the PML-RARα probe reported no fusion in 325 interphase nuclei examined ( Fig. The FISH signals from Vysis indicated abnormal BCR/ABL1 fusions in 304 of 312 (97.4%) interphase nuclei examined ( Fig.

Chromosomal analysis by G-banding showed 46,XX,t(9 22) (q34 q11) in 23 cells among the 25 metaphase cells analyzed ( Fig. Special staining showed negativity to all of MPO, Sudan black B, and specific and nonspecific esterases and periodic acid-Schiff staining.

Prothrombin time (PT) and activated partial prothrombin time (aPTT) were in the normal range (PT 13.5 sec aPTT 25.5 sec), and fibrinogen was slightly increased (467.5 mg/dL).Ī bone marrow (BM) aspiration and biopsy showed markedly hypercellular marrow and increased blasts (about 23.8% of all nucleated cells) with predominantly lymphoblast morphology with scant cytoplasm without Auer rods ( Fig. Initial blood test revealed elevated white blood cell (WBC) count with blasts (WBC 287.520×10 9/L segmented neutrophil 32% metamyelocyte 2% myelocyte 13% eosinophil 2% basophil 1% blast 13% Hb 9.6 g/dL platelets 187×10 9/L). The liver and lymph nodes were not palpable. On physical examination, the spleen was palpable 10 cm below the lower costal margin on the left mid-clavicular line. However, by far, there is no report about the expression of PML-RARα fusion transcript in Philadelphia chromosome-positive (Ph+) MPAL patients.Ī 37-year old female presented with a two-week history of neck and pelvic area pain, fever, and chills. The detection of t(15 17) in biphenotypic acute leukemia (BAL) with French-American-British (FAB) L2 morphology has been rarely reported, including one with PML-RARα fusion transcript and the other without PML-RARα fusion transcript. Cryptic or masked t(15 17) (q24 q21) in APL, which has morphological APL and PML-RARα fusion transcript but no t(15 17)(q24 q21) on routine cytogenetic analysis, has been noted. Promyelocytic leukemia ( PML) and retinoid acid receptor α (RARα) fusion transcript is a product of translocation of chromosome 15 and 17, which is a hallmark of acute promyelocytic leukemia (APL). TO THE EDITOR: About 1–5% of the acute leukemias are not possible to assign a single lineage, which is designated as mixed phenotype acute leukemia (MPAL).

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